Billing and Reimbursement
To bill for Cerezyme therapy, you must use the appropriate codes. The billing procedures may vary according to the site of service or third-party payer guidelines. Please reference this site or call a Genzyme Case Manager for updated billing codes.
In addition to the reimbursement expertise provided by our Case Managers, Genzyme also offers the following downloadable resources to help guide you through the process:
The Centers for Medicare and Medicaid Services (CMS) issued a unique HCPCS billing code for Cerezyme®.
2011 billing instructions for Cerezyme:
HCPCS code: J1786
Administration: Cerezyme® - injection, imiglucerase
The unique J-code assigned to Cerezyme, significantly streamlines the reimbursement process. Cerezyme is eligible for reimbursement by commercial payers and Medicare.
However, specific policies vary across insurers and from plan to plan. Use the links below to find reimbursement information for the following payer types:
- Private Payers – Understand the reimbursement guidelines for commercial payers, including specialty pharmacy.
- Managed Care – Find out about Managed Care reimbursement across different settings of care
- Medicaid Managed Care – Understand general reimbursement requirements across state Medicaid agencies
Indication & Usage
Cerezyme® (imiglucerase for injection) is indicated for long-term enzyme replacement therapy for pediatric and adult patients with a confirmed diagnosis of Type 1 Gaucher disease that results in one or more of the following conditions:
- bone disease
- hepatomegaly or splenomegaly
Important Safety Information
Approximately 15% of patients have developed IgG antibodies, and these patients have a higher risk of hypersensitivity reaction. Therefore periodic monitoring is suggested; caution should be exercised in patients with antibodies or prior symptoms of hypersensitivity. Symptoms suggestive of hypersensitivity occurred in 6.6% of patients, and include anaphylactoid reaction, pruritus, flushing, urticaria, angioedema, chest discomfort, dyspnea, coughing, cyanosis and hypotension.
Reactions related to Cerezyme administration have been reported in less than 15% of patients. Each of the following events occurred in less than 2% of the total patient population. Reported adverse events include nausea, abdominal pain, vomiting, diarrhea, rash, fatigue, headache, fever, dizziness, chills, backache, and tachycardia. Adverse events associated with the route of administration include discomfort, pruritus, burning, swelling or sterile abscess at the site at the site of injection.
To report suspected adverse reactions, contact Genzyme at 800-745-4447, option 2 or FDA at 800-FDA-1088 or http://www.fda.gov/Safety/MedWatch
Please see Full Prescribing Information (PDF).